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超声引导下经皮微波消融与CT超声引导下肿瘤射频消融治疗原发性肝癌的临床比较

作者:李丽珍1 钟秋红1 黄昌辉2 陈成彩1

所属单位:1.右江民族医学院附属医院超声科(广西 百色 533000) 2.右江民族医学院附属医院放射科(广西 百色 533000)

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摘要

目的 探讨超声引导下经皮微波 消融与CT超声引导下肿瘤射频消融治疗原 发性肝癌的临床比较。方法 选取2009年 2月-2013年3月我院微创介入治疗科收治 的46例(72个病灶)原发性肝癌患者为研究 对象,随机数字表法均分为研究组和对照 组,对照组行超声引导下经皮微波消融治 疗,研究组行CT超声引导下肿瘤射频消融 治疗,观察两组围术期相关指标[手术时 间、术后住院时间、住院费用],消融情 况[消融点数、消融时间]、临床疗效影像 学评价、3年随访复发率。结果 研究组手 术时间、术后住院时间分别均较对照组 显著短(P<0.05),两组住院费用相较无 显著差异(P>0.05);两组术后病灶均较 好地清除;研究组3年复发率较对照组显 著低,差异具有统计学意义(χ2 =5.254, P<0.05)。结论 超声引导下经皮微波消 融与CT超声引导下肿瘤射频消融对原发性 肝癌的临床疗效均显著,射频消融在手术 时间、住院时间、消融时间、3年复发率 方面均具有更显著优势,值得临床推广应 用。

Objective Tocompare the effects between ultrasound-guided percutaneous microwave ablation and CT ultrasound-guided radiofrequency ablation in treating primary liver cancer. Methods Forty-six patients (72 lesions) with primary liver cancer treated by minimal invasive interventional therapy in our hospital between February 2009 and March 2013 were selected as study subjects and were equally divided into study group and control group by the random number table method. The control group received ultrasound-guided percutaneous microwave ablation while study group received CT ultrasound-guided radiofrequency ablation. The related perioperative indexes (operation time, postoperative length of stay, hospitalization expenses), state of ablation (ablation count, duration of ablation), imaging evaluation of clinical efficacy, 3 year follow-up recurrence rate in the two groups were observed. Results Operation time and postoperative length of stay of study group were significantly shorter than control group (P<0.05). There was no significant difference in hospitalization expenses between the two groups (P>0.05), after operation, lesions in both groups were effectively removed. The 3-year recurrence rate in study group was significantly lower than control group (χ2 =5.254, P<0.05). Conclusion Clinical efficacy of both ultrasound-guided percutaneous microwave ablation and CT ultrasound-guided radiofrequency ablation are significant in treating primary liver cancer. Radiofrequency ablation has more advantages in operation time, length of stay, duration of ablation and 3-year recurrence rate.

【关键词】原发性肝癌;经皮微波消融; 超声引导;肿瘤射频消融;CT

【中图分类号】R657.3

【文献标识码】A

【DOI】10.3969/j.issn.1672- 5131.2017.01.024

前言

原发性肝癌为国内常见恶性肿瘤之一,发病率较高,危害较大, 以肝区疼痛、腹胀、乏力、纳差、消瘦、黄疸、腹水等为主要临床表 现,严重威胁患者生存质量[1];虽早期肝癌以手术切除为主要治疗手 段[2],但国内肝癌患者大多由乙肝、肝硬化等发展而来,绝大部分患 者身体状况较差,且多发病灶位于不同叶段、病灶靠近大血管等,加 之较多高龄患者合并有心脑血管疾病及糖尿病,已然已失去外科手术 切除机会。随着医疗技术不断进展,射频及微波消融治疗在肝癌治 疗中逐渐被医务人员及患者认可[3],两种治疗方法均属于热凝治疗, 都具有创伤小、疗效切确、可重复性等显著优点,为临床中较为常用 的热消融技术,两者均逐渐成为非手术治疗患者的首选方法[4],为进 一步探究两种微创消融技术在肝癌患者治疗中各自优势,对2009年2 月~2013年3月我院微创介入治疗科收治的46例(72个病灶)原发性肝癌 患者进行临床对照研究,研究结果简述如下。